As a person ages, the skin, underlying connective tissue, and muscle undergo changes that result in wrinkles and sagging skin. These changes occur all over the body but are often most noticeable in the face.
Current methods for reducing wrinkles and tightening sagging skin include surgical procedures, such as rhytidectomy (i.e., a face lift), brow lifts, and blepharoplasty (i.e., eyelid surgery), botulinum toxin injection, and skin resurfacing techniques (e.g., chemical peels).
Surgical procedures for tightening sagging skin usually involve making an incision in the skin and underlying layers, elevating the skin and soft tissue, and stretching the underlying muscle and membrane layers to a desired level of tightness. The amount by which sagging skin may be tightened is often limited by the underlying elasticity of the muscle and membrane layers and the degree to which these layers relax after surgery.
Surgical procedures for reducing wrinkles involve selectively destroying muscles, or parts of muscles that primarily contribute to the formation of wrinkles. Selective muscle destruction may be performed openly or endoscopically; however, both techniques require direct visualization of the muscle groups and employ invasive procedures, such as avulsion, incision, and direct cautery for removing portions of muscle. Because of their invasive nature, surgical procedures often require prolonged recovery time, and put patients at risk for potential complications, such as hematoma.
Botulinum toxin injection reduces wrinkles by temporarily paralyzing muscles whose movement causes skin to wrinkle. Patients may have variable responses to an injection of the same dosage depending on patient factors that are not determinable prior to injection. Because the effects of an injection are temporary, repeated injections are typically needed every four to six months to maintain a desired result. Furthermore, when the toxin is applied to the forehead and brow, the resulting muscle paralysis may cause brow ptosis and/or a noticeable loss of facial animation.
Skin resurfacing techniques include delivery of energy to layers of the skin including the epidermis and dermis using lasers, chemical agents, and radiofrequency delivery devices. These techniques often have limited penetration depth and therefore are limited to treating superficial layers of the skin. Some skin resurfacing techniques may cause uneven pigmentation in the skin. Although these techniques may improve the texture of the skin, they often do little to tighten sagging skin and to reduce wrinkles.